The power of place

Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth.

To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth.

A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic.

Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror.

The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

The birth environment can help or hinder physiological birth and influence a woman’s level of satisfaction with birth.

This paper gives new theoretical insights into how spatial architecture influences birthing women and their birth processes. It builds the architectural awareness of midwives/ designers need by linking design regulations/recommendations and experiential aspects of birth spaces architecture.

Two qualitative methods were used: (1) a regulation/policy document critique, and (2) childbearing women’s spatial experiences explored in semi-structured interviews with drawing methods (24 mothers in a case study location in the north of England, UK). Themes emerged from semiotic (documents/visual data) and thematic (transcripts) analysis, and their relationships explored.

The regulatory documents revealed four spatial categorization concepts: (1) medical risk; (2) a tripartite clinical approach; (3) single-function birth space; and (4) a woman-centered approach. In contrast, women experience birth spaces architecture as an amalgam of all the spaces they use and in affective, interpersonal. Two patterns of spatial use emerged from the interviews: (1) ‘wait and transfer’ (more common in healthcare buildings); and (2) ‘curate and prosume’ (more common in women’s homes). Women gave greater positive descriptions of the ‘curate and prosume’ pattern.

The influence of building regulations on hospital settings and women’s prior experiences of such spaces through appointments and antenatal education, shape women’s spatial experiences of childbirth. This new evidence can act as a catalyst to evolve birth space design towards delivering woman-centered and personalized care in spaces designed for women to ‘curate and prosume’.

The aim of this study was to gain knowledge regarding how Norwegian nulliparous women experience planned home birth and why they choose this route of giving birth.

A qualitative approach was used, and the study data were derived from semi-structured individual interviews, which were analysed through systematic text condensation.

Ten Norwegian women aged nineteen to thirty-nine years were interviewed. They had each gone through with a successful planned home birth of their first child within the last two years. These women all resided in the middle, western and eastern areas of Norway. A certified midwife was present throughout the labour and birth, and no transfer to the hospital was necessary.

The following two main themes were identified: ‘inner motivation’ and ‘giving birth in safe surroundings’. The women in this study had a strong inner faith in the normal physiological processes of labour and birth and had educated and prepared themselves carefully for their planned home birth. To be able to enter one's own inner world was considered crucial for labour, and the trusting relationship they had with their midwife made this possible.

Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.

In hospital units, the network of interdependent relationships between midwives and doctors has positioned midwives within hierarchical relationships of power. Others argue that the physical layout of hospital wards created by biomedicine makes it difficult for midwives to provide midwifery led care. The aim of this review is to identify factors that support change in the delivery of the midwifery led care in hospital settings.

A narrative review was chosen as this method allows for greater flexibility in the selection of studies and can lead to the inclusion of a wider range of literature.

Eight high quality papers from the UK, Sweden, Canada and Australia were selected for review. Papers focused on improving the delivery of midwife led care in hospital midwifery units, labour and postnatal wards. Key themes were identified as supporting change in the delivery of midwifery led care were ownership of change, capability to change and transformational leadership.

The findings demonstrate the importance of social support and clinical leadership in bringing about subtle changes in hospital based midwifery led care. Ultimately improved understanding of the factors that support the delivery of the midwifery led care in hospital settings may improve women’s choice and highlight the role of the midwife as the practitioner of normal childbirth.

limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and environment of a birth space. Domestic aesthetics in a birth space are believed to be an important aspect of optimal birth unit design.

to explore the concept of domesticity within the birth space. The specific objectives were to explore, describe and compare birth spaces with different domestic characteristics and subsequently, how laboring women worked within these spaces during the labour process. This project was situated within a larger ongoing body of work exploring birth unit design.

a qualitative approach, using the techniques of video ethnography and reflexive interviewing, was used. Video data consisted of films of the labours of six Australian women who gave birth in 2012. Filming took place in two different tertiary hospitals in Sydney NSW (n=5 women), as well as a stand-alone Birth Centre (n=1 woman). Video footage of a woman labouring at home was used to compare and contrast women's experiences. Latent content analysis was used to analyse the data set. In addition there were 17 one-hour video-reflexive interviews that were audio-taped and fully transcribed (nine interviews with women and/or their support people and eight with midwives). Field note data accompanied both the video recording as well as the reflexive interviews.

in general, women labouring in conventional hospital labour and birth rooms acted and interacted with the environment in a passive way. The spaces clearly did not resemble homely or ‘domestic’ spaces. This forced women to adapt to the space. In essence all but one of the women labouring and birthing in these spaces took on the role of a ‘patient’. One participant responded quite differently to the conventional hospital space. ‘Domestication of the space’ was the mechanism this woman used to retain a sense of ownership within the birth space. In contrast, in the domestic birth environments (Birth Centre and home) women effortlessly claimed ownership of the space, expressing their identity in a myriad of ways. In these domestic spaces, women were not required to change or modify their birth spaces as the design, furnishings and semiotics of the space openly encouraged them to be active, creative and take ownership of the space.

the findings of this study add to the existing literature on birth unit design and more specifically contribute to an understanding of how the features of domesticity within the birth setting may shape the experience of labouring women and their care providers. The evidence gained from the study will assist in the ongoing movement to humanise birth spaces and develop further understandings of how home-like birth spaces should look. Those designing, building, furnishing, managing, accessing and working in Birthing Services could all benefit from the consideration of how environments designed for the care of birthing women, may be affecting the outcomes and experiences of women and their families.

Geographers have long grappled with how their research can positively impact individuals, communities and society. Demonstrating research impact is an increasingly important aspect of academic life internationally. In this paper we argue that agendas for encouraging ‘impact’ would be well-served if impact through teaching was identified and stimulated more explicitly, and if academics better recognised and seized the opportunities that already exist for such impact. We take engagement between health geography and nurse education as an example of how social scientists could demonstrate research impact through inter-disciplinary involvement in the education of health care professionals, and specifically student nurses. We begin by showing how the UK's Research Excellence Framework (widely regarded as the key reference point for research performance management regimes internationally) has tended to produce an undervaluation of impact via education in many disciplines. A comprehensive overview of international scholarship at the intersection between geography and nursing is then presented. Here we trace three ‘waves of enquiry’ that have focused on research interactions before calling for a fourth focused on critical pedagogy. To illustrate the possibilities of this fourth wave, we sketch a case study that outlines how engagement with research around blood donation could help provide a foundation for critical pedagogy that challenges student nurses to practice reflexively, think geographically and act justly. Finally, we call for closer engagement between health geography and nurse education, by encouraging educators to translate, teach, and transfuse ideas and people between health geography and nurse education. In so doing, we argue that work at this interface can be mutually beneficial and demonstrate impact both within and beyond research assessment rubrics. Hence, our ideas are relevant beyond nurse education and geography insofar as this paper serves as an example of how reframing research impact can recover the importance of impact through education.